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everett CHART NO. �� �_17-T <br /> ✓ �"�— <br /> . e ���T�� <br /> � �_„ _ � sr ; ; <br /> City of Everett � - <br /> � Engineering & Commimity Services , <br /> � <br /> ; Sewer Application and Permit � <br /> ; , - <br /> j N0. � DATE � X� �/ _— <br /> � <br /> � Service Address / y���! .>> � -<.- . '; t� . � _ � <br /> i �-!� Utility Account No._ � �/— �' %S' UD <br /> � BillingAddress_ ����� L' , �`�%"4/ ' _ .�.pefmit Fee �--- <br /> iCi[y, State, Zip_ � ��� �� �,i . ��"�' � �� Connection Charge�s) '—�'� <br /> iOwner (Mortgagor) "'C r->n/ ��%�._".— � Total Fee -' " � �.-� <br /> � Billing Name ' (.�• <br /> � -.,, <br /> � i , <br /> I Connection By_ �_ '-T �--�;_' T/'�� _ <br /> � � i <br /> i Address Signed :'r.:-�- ���,, :�� V <br /> /Cusromer <br /> Phone_ <br /> DES RIPTIOfV: Sewer District <br /> � Lot '- �� F Block �� <br /> I ' ' Monthl c� •� %V <br /> Plat �( �� ,i <.L-i- . � y ..wer Service <br /> � Unplatted Description Monthly Sewer Constr. <br /> ��; ° �" Trunk �• �� <br /> j Type Permit: i , , <br /> I — � ,rt- i. . : ,, <br /> Lateral <br /> ', =,.s' <br /> I Remarks: _ <br /> Abutting Lot Line <br /> ,��w.,f"�-!.� .. �' �. <br /> ��rtc . �C_.L[�.� .�� N, S, E, W ft. <br /> • � iir`— — — <br /> 70 _i.,w:.✓ 7 i/rr..., I- i�` / <br /> � �,� ' �.!_:/., . s/'�Cc�d'L ` <br /> i ---= Approved B�_ �� <br /> � Cny Enpineer <br /> � <br /> i _ � — Issued By ' � ' _._,.✓,• .�_ <br /> � <br /> Inspection By���.a�-��}-�� <br /> I o —____._..__ Datelnspected �IJ_- y 7 - 7 7 _ , <br /> ( SEESKETCH ATTACNED N� <br /> I � <br /> � <br />